Acute-on-chronic liver failure designation in patients with severe alcohol-associated hepatitis undergoing liver transplantation.

Acute-on-chronic liver failure (ACLF) is associated with high mortality, yet its distinction from severe alcohol-associated hepatitis (SAH) remains unclear despite overlapping clinical features. We aimed to determine the prevalence of ACLF (by ACLF criteria by the North American Consortium for the Study of End-Stage Liver Disease (NACSELD) among liver transplant (LT) recipients with SAH and compare this with other liver disease etiologies. This short study found that ACLF is common among LT recipients, particularly in those with recent alcohol use, but is not more prevalent in SAH compared to other alcohol-associated liver disease presentations. Current ACLF definitions may underrecognize disease severity in SAH, as most SAH patients demonstrated advanced fibrosis or cirrhosis. Standardized diagnostic criteria integrating ACLF and SAH are needed to better stratify risk and guide transplant evaluation.